Benefits of Neurohormonal Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices

Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least 2 years post-LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. Neurohormonal blockade use was treated as a time-dependent predictor. Stepwise selection indicated treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) (hazard ratio [HR] = 0.53 [0.30–0.95], p = 0.03), age at the time of implantation (HR = 1.28 [1.05–1.56] per decade, p = 0.02), length of stay postimplantation (HR = 1.16 [1.11–1.21] per week, p
Source: ASAIO Journal - Category: Medical Devices Tags: Adult Circulatory Support Source Type: research

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ConclusionsAcute asymptomatic rejection is rare after the second post ‐transplant year. Obtaining surveillance studies beyond the second post‐transplant year is not cost‐effective.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
AbstractPurpose of the ReviewAlthough still a relatively new technology, long-term left ventricular assist devices (LVADs) for management of advanced heart failure is rapidly increasing. Initially designed as a bridge to transplant, these invasive devices are increasingly used as a destination therapy, creating unique and long-term infection risks. The aim of this comprehensive review is to highlight current evidence about the prevention, diagnosis, and management of LVAD-specific infections.Recent FindingsThere are two recent, major societal guidelines (The International Society for Heart and Lung Transplantation, 2017, a...
Source: Current Infectious Disease Reports - Category: Infectious Diseases Source Type: research
Abstract Transthyretin amyloid cardiomyopathy (ATTR-CM) results in a restrictive cardiomyopathy caused by extracellular deposition of transthyretin, normally involved in the transportation of the hormone thyroxine and retinol-binding protein, in the myocardium. Enthusiasm about ATTR-CM has grown as a result of 3 simultaneous areas of advancement: Imaging techniques allow accurate noninvasive diagnosis of ATTR-CM without the need for confirmatory endomyocardial biopsies; observational studies indicate that the diagnosis of ATTR-CM may be underrecognized in a significant proportion of patients with heart failure; an...
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
Left ventricular assist device (LVAD) therapy is a form of mechanical support for patients with advanced heart failure as either a bridge to transplant or destination therapy. The association between gastrointestinal bleeding (GIB) and LVAD recipients is well established. Previous studies have indicated device differences between Heartmate II (HM II) and Heartware. The aim of this study was to further investigate these differences, identify associations with GIB, and further understand endoscopic management of GIB among LVAD recipients.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Poster abstracts Source Type: research
AbstractVarious cell-based therapies are currently investigated in an attempt to tackle the high morbidity and mortality associated with heart failure. The need for these therapies to move towards the clinic is pressing. Therefore, preclinical large animal studies that use non-autologous cells are needed to evaluate their potential. However, non-autologous cells are highly immunogenic and trigger immune rejection responses resulting in potential loss of efficacy. To overcome this issue, adequate immunosuppressive regimens are of imminent importance but clear guidelines are currently lacking. In this review, we assess the i...
Source: Journal of Cardiovascular Translational Research - Category: Cardiology Source Type: research
Ventricular assist devices (VADs) are an increasingly common therapy for end-stage heart failure across all ages as a bridge to recovery or transplant and more recently as destination therapy. With increasing experience and difficulties with establishing therapeutic heparin levels, we have begun to explore the effectiveness of direct thrombin inhibitors in this patient population. This is a retrospective review of all long-term VAD patients, both adult and pediatric, who were anticoagulated with bivalirudin between January 2009 and January 2016. The starting dose was 0.3 mg/kg/hr, and dose was titrated for a goal pa...
Source: ASAIO Journal - Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research
AbstractPurpose of ReviewWith the growing need for donor hearts and longer transplant waiting lists, there is a growing interest in expanding the donor pool by reconsidering previously excluded donor candidates. There has been an increase in solid organ availability due to drug overdose deaths in the setting of the recent opioid epidemic. However, these donors often have transmissible infections such as hepatitis C. In this review, we discuss the challenges associated with heart transplantation from hepatitis C –infected donors as well as the recent advancements that are making the use of these organs possible.Recent...
Source: Current Heart Failure Reports - Category: Cardiology Source Type: research
Medtronic is recalling its HeartWare HVAD pump outflow graft and outflow graft strain relief because of the risk of breaks and tears during the pre-implant pump assembly process. FDA has identified this as a Class I recall. The Dublin-based company said it has received 92 complaints. The recalled products according to FDA’s release are: HeartWare HVAD Pump Outflow Graft and Outflow Graft Strain Relief Model Numbers:HVAD Pump Outflow Graft: 1125 HVAD Pump Implant Kit: 1103 HVAD Implant Accessories Kit: 1153 Distribution Dates: March 1, 2018 to April 1, 2020   Medtronic said the use of the affe...
Source: MDDI - Category: Medical Devices Tags: Cardiovascular Regulatory and Compliance Source Type: news
Conclusions: The SR-A1-c-Myc axis may represent a promising target to treat DiCM through augmentation of cardiac resident reparative macrophage proliferation. PMID: 32466726 [PubMed - as supplied by publisher]
Source: Circulation Research - Category: Cardiology Authors: Tags: Circ Res Source Type: research
AbstractAdvances in surgery and pediatric care over the past decades have achieved improved survival for children born with congenital heart disease (CHD) and have produced a large, growing population of patients with adult congenital heart disease (ACHD). Heart failure has emerged as the leading cause of death and a major cause of morbidity among the ACHD population, while as little evidence supports the efficacy of guideline-directed medical therapies in this population. It is increasingly important that clinicians caring for these patients understand how to utilize mechanical circulatory support (MCS) in ACHD. In this r...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
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